Impact of novel histopathological factors on the outcomes of liver surgery for colorectal cancer metastases

Serrablo, Alejandro; Paliogiannis, Panagiotis; Pulighe, Fabio; Moro, Sánchez; Borrego-Estella, Vicente M.; Attene, Federico; Scognamillo, Fabrizio; Hörndler, C.

doi:10.1016/j.ejso.2016.02.013

Cited by 25 publications

(23 citation statements)

References 44 publications

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“…However, the significance of the dimensions of metastatic lesions as prognostic factors in CRLM surgery is controversial. Indeed, two independent studies found that the dimensions of metastases were not associated with local recurrence or 5-year survival rates (24,25). Thus, only the dimensions of metastases cannot be considered an exclusion criterion for surgery, unless they compromise the resection margins or the residual functional parenchyma (24).…”

Section: Discussionmentioning

confidence: 99%

Maximum Diameter and Number of Tumors as a New Prognostic Indicator of Colorectal Liver Metastases

Yoshimoto

Morine

Imura

et al. 2017

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Abstract. Background: Surgical resection is currently considered the only potentially curative option as a treatment strategy of colorectal liver metastases (CRLM). Patients with MDN ≥30 had shown significantly poorer prognosis than patients with MDN <30 in OS and relapse-free survival (RFS). Conclusion: MDN ≥30 is an independent prognostic factor of survival in patients with CRLM and optimal surgical criterion of hepatectomy for CRLM.The liver is the most common site of metastasis in patients with colorectal cancer (CRC) (1), with 15-25% of patients presenting synchronous colorectal liver metastases (CRLM) (2). In addition, another 25-50% of patients develop subsequent metachronous metastases during the course of the disease (2, 3). Surgical resection is currently considered the only potentially curative option for patients with metastatic CRC confined to the liver (4, 5), and is associated with a 5-year overall survival (OS) rate of 37-58% (6). However, only 15-30% of patients with liver metastases may be initially resectable (7,8), but the criteria for selection of resectable CRLM remain unclear.According to Nordlinger et al., patients with CRLM have been classified into three clinical categories: (i) patients with resectable metastatic disease; (ii) patients with metastatic disease that is not optimally resectable (tumor size >5 cm, >4 metastases, synchronous CRLM, primary lymph node (LN)-positive, positive tumor markers and/or technically difficult) and (iii) patients unlikely to ever become resectable (9). Neoadjuvant chemotherapy was recommended for patients with resectable and unresectable CRLM, whereas first-line surgical resection was recommended only for patients with solitary metastases ≤2 cm and good prognostic features (10). In the European Society for Medical Oncology (ESMO) consensus guidelines for the management of patients with CRLM, patients were categorized by technical and oncological criteria. Oncological categories include (i) concomitant extrahepatic disease; (ii) number of lesions ≥5; (iii) tumor progression, with no mention of tumor size (11). However, clear criteria of surgical resection for CRLM have never been established.On the other hand, in hepatocellular carcinoma, the Milan criteria are used for a simple selection for liver transplantation around the world. The adaptation of liver transplantation was limited to one lesion smaller than 5 cm or up to 3 lesions smaller than 3 cm, and it is representing an approximate volume of tumor. In CRLM, simple criteria, using tumor number and size are required.Perioperative or neoadjuvant chemotherapy with various agents, alone or in combination, is the standard of care for most patients with CRLM (12, 13). Neoadjuvant chemotherapy in patients with initially unresectable CRLM can reduce metastasis sizes, converting initially unresectable to resectable lesions (conversion treatment) (9), making systemic chemotherapy in combination with liver resection an accepted 419

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Section: Discussionmentioning

confidence: 99%

Maximum Diameter and Number of Tumors as a New Prognostic Indicator of Colorectal Liver Metastases

Yoshimoto

Morine

Imura

et al. 2017

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“…In addition, the specific number of nodules that drives a worse prognosis is actively debated. Whereas most authors consider four or more lesions to be a relative cut‐off associated with a worse prognosis, other investigators have reported more than one, two or even more than seven lesions . The highest level of evidence comes from a meta‐analysis conducted by Smith and McCall, which evaluated 9934 patients who underwent potentially curative therapy (surgical resection and/or ablation).…”

Section: Number Of Liver Metastasesmentioning

confidence: 99%

“…As with tumour number, there is no consensus on the size cut‐off that dictates a worse outcome, and some studies even dispute whether size matters at all. A few studies, most of them evaluating patients treated in the 1980s, have failed to detect any relationship between CRLM size and recurrence or survival . Lesions larger than 50 mm are most commonly associated with a worse prognosis, whereas some studies have utilised 80 mm as the cut‐off size .…”

Section: Size Of Liver Metastasesmentioning

confidence: 99%

“…Microscopically negative margins (R0) have traditionally been considered to constitute an important prognostic factor after CRLM resection . Most authors have reported that microscopically positive (R1) or macroscopically positive (R2) margins are associated with worse long‐term overall survival . However, the definition of R0 or R1 resection can change according to the study.…”

Section: Margin Sizementioning

confidence: 99%

“…also reported that the infiltrative growth pattern was an independent poor prognosis factor for survival after CRLM resection. Only one study did not find an infiltrative growth pattern to be a prognostic factor …”

Section: Tumour Growth Patternmentioning

confidence: 99%

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Pathological factors and prognosis of resected liver metastases of colorectal carcinoma: implications and proposal for a pathological reporting protocol

et al. 2017

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Colorectal cancer is a leading cause of death worldwide. The liver is the most common site of distant metastases, and surgery is the only potentially curative treatment, although the recurrence rate following surgery is high. In order to define prognosis after surgery, many histopathological features have been identified in the primary tumour. In turn, pathologists routinely report specific findings to guide oncologists on the decision to recommend adjuvant therapy. In general, the pathological report of resected colorectal liver metastases is limited to confirmation of the malignancy and details regarding the margin status. Most pathological reports of a liver resection for colorectal liver metastasis lack information on other important features that have been reported to be independent prognostic factors. We herein review the evidence to support a more detailed pathological report of the resected liver specimen, with attention to: the number and size of liver metastases; margin size; the presence of lymphatic, vascular, perineural and biliary invasion; mucinous pattern; tumour growth pattern; the presence of a tumour pseudocapsule; and the pathological response to neoadjuvant chemotherapy. In addition, we propose a new protocol for the evaluation of colorectal liver metastasis resection specimens.

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Neoadjuvant Chemotherapy for Resectable Colorectal Cancer Liver Metastases: Indications and Results

Ryan

Bridgewater

2019

Colorectal Cancer Liver Metastases

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Impact of novel histopathological factors on the outcomes of liver surgery for colorectal cancer metastases

Cited by 25 publications

References 44 publications

Maximum Diameter and Number of Tumors as a New Prognostic Indicator of Colorectal Liver Metastases

Maximum Diameter and Number of Tumors as a New Prognostic Indicator of Colorectal Liver Metastases

Pathological factors and prognosis of resected liver metastases of colorectal carcinoma: implications and proposal for a pathological reporting protocol

Neoadjuvant Chemotherapy for Resectable Colorectal Cancer Liver Metastases: Indications and Results

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